Evidence into Practice: systematically improving the outcomes of prevention in Primary Care

Summary

NHS Greenwich face some major healthcare challenges with significant health inequalities existing within the locality. Overall, life expectancy is worse than the England average.

Men living in the least deprived wards of Greenwich can expect to live for an average of seven years longer than those in the most deprived wards and for women the difference is nearly five years1. Diabetes is a major contributor to premature death in the borough.

NHS Greenwich is one of 13 PCTs identified by the National Health Inequalities Support Team that account for 40 per cent of the national gap in life expectancy2.

Results

Evidence into Practice was piloted in Greenwich in 14 practices that received the programme on a service to medicine basis sponsored by MSD. These practices were selected using a series of health inequalities markers.

The Greenwich guidelines for diabetes 2011 were used as the evidence base for all of the clinical exercises with the aim of ensuring a systematic and consistent approach to their implementation across Greenwich3.

MSD facilitators worked with the pilot practices to ensure that they progressed through the programme milestones in a timely manner.

Results: Prevention and Productivity
In the pilot practices there was a 12 per cent decrease in diabetic medicine outpatient attendances over the previous year (09/10 – 10/11) in comparison, non-pilot practices experienced an 1 per cent increase over the same period7. Figures standarised per 1000 patients with diabetes.

In the pilot practices there was a 8 per cent decrease in all CVD admissions over the previous year (09/10 – 10/11) in comparison, non-pilot practices experienced a 2 per cent increase over the same period7. Figures standarised per 1000 patients with diabetes.

NHS Greenwich have calculated that Evidence into Practice’s Year 1 impact in relation to saved and avoided CVD admissions and Diabetes outpatient attendances is £177,734 and £23,385 in the pilot practices respectively:
  • A total saving of £201,1197
  • An average saving of £14,635 per practice7

For further information on the results of the pilot and NHS Greenwich plan for the future please refer to the pdf in Resources

Challenge

Diabetes has been highlighted as a major contributor to premature death in Greenwich, both as a direct result of the disease and indirectly through associated cardiovascular events3.

Recent QoF figures show there are 10,033 patients with recorded diabetes. However, the Yorkshire and Humber Public Health Observatory (YHPHO) prevalence model estimates the actual figure to be 12,900, suggesting that more than 22 per cent of patients are undiagnosed. Diabetes prevalence is estimated to rise to 16,068 patients by 2020, an increase of 37 per cent4.

Solution

In order to improve health outcomes for patients, NHS Greenwich have set 4 strategic goals. The second of these goals is to realise the full potential of primary and secondary prevention. The aim was to manage this through systematic and proactive ‘population sized’ prevention programmes that would ensure consistent service provision and quality is across the borough. This includes:5

  1. Strong and consistent referral relationships between primary care teams and prevention services (eg, smoking)
  2. Increasing skills and confidence of primary care practitioners – cultural shift to proactive approach
  3. Implementation of new vascular risk screening programme
  4. Improve uptake of screening and immunisation programmes
  5. Improvement in effective management of patients with existing conditions like diabetes
  6. Using social marketing to deliver prevention services
  7. Training and development of primary care team to extend their health promotion role

Evidence into Practice: systematically improving the outcomes of prevention in Primary Care
by

Resources